Provider Demographics
NPI:1023235801
Name:RODZIEWICZ, BONNIE RUTH
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:RUTH
Last Name:RODZIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28442 MALVINA DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6316
Mailing Address - Country:US
Mailing Address - Phone:586-771-1497
Mailing Address - Fax:586-774-0195
Practice Address - Street 1:28442 MALVINA DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6316
Practice Address - Country:US
Practice Address - Phone:586-771-1497
Practice Address - Fax:586-774-0195
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist